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000299 <br /> APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JDAOUIN COUNTY PUBLIC HEALTH SERVICES a1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RO.BOX M-304 EAST WEBER AVENUE,STOCKFOR CA SMI- @8 Q� <br /> (2091 458.3420 <br /> NON REFUNDABLE PEBNNT EXPIRES I YEAR FROM DATE ISSUED <br /> {CEIRPYLF is 7r*A to) <br /> APPLICATION IS WWRY MADE TO THE CAN JOAQUIN COUNTY FOR A REMIT TO CONSTRUCT ANO/OR INSTALL THE WORK DESCRIBED. THIS APPUCATION M MADE IN COMPLIANCE WITH SAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE/.CHAYTFA g-I1 T0.3 ANO T <br /> JCtA�OLHEALTH--SERVICES, <br /> yETRRTVV•[IICES,EIR/7O�NMTjETNTALC HEALTH <br /> DONVEISGNf�. <br /> CR <br /> 3S�S Q�JkjQJ08 AODREASIOR APNR 7/ F <br /> OWNER'S NAME AeAfG Qen ADOPFSCPMONEAL4 g,'I7 <br /> CONTPACTOR-AP2"YLIC! T� <br /> l <br /> SUB CONTRACTOR ADDRESS LIC! �^PHONe <br /> TYPE OF t4DTRC WORRC: NEW INSTALLATION❑ REPARVADDITON ----- <br /> DEETwenoN❑ <br /> IND SEPTIC SYSTEM PEFMTTTED IF PUBLIC SEWER IS AVNLABLE WITHIN 200 FEET OF BUIL NO.J PeIO TESTIA I R HOW MANY <br /> APESSSla:/ <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL El <br /> U OTHER❑ <br /> NLOMER Of LIVING UNITS: Z NUMBER OP SWAOOIAS: NLR AASE OF EAISOYETS: <br /> CH R OF SOIL TO A DEPTH OF 3 FEET!. FTTISUMMP SOIL CHARACTER: WATER TABLE DEPTH- '1t9 <br /> C T MEASE TRAP ❑TYFEAAFG <br /> CAPACITY NO.COMPARTMIEM/ <br /> PKG TRSATMO/T PLANT❑ DIiTARCi To NEAREST: WELL, FOINJOATgN_/s r IMe014RTY LUN! dLa <br /> UFT STATION 0 BT(E TYPE OF PUMP RANO OIL SEPARATOR 40 CLOSM SYSTEM) <br /> LFACHINO UNE ❑ NO,A LENGTH OF USES_ OISTAMETO NEARE6T:WELL FOUNDATION F OPERTYr UN¢ <br /> FILTER Sm ❑WIOTH LENOTH__DEPTH DISTANCETO NEAREST:Wal RHJkDATION PROPERTY UNE <br /> MOUNDED 13 MOTH LENGTH DEPT)L 018TANCE TO NEAREST:WELL__FOUNDATION PROPERTY LOW <br /> SFF7AGI ATA D DEPTH GIVE_,NUMBER DISTANCE TO NEAtECF:WELL _POUNCATIOPROPERTY L <br /> SNOOPS ❑WIDTH LENGTH 7EPTH DISTANCE TO NEAREST.WELL_` N UNE <br /> FOUNDATION PROPERTY LME <br /> DISPOSAL PONDS ❑WIDTH LENOTH DEPTH DISTANCE TO NEAREST:WELL--FOUNDATION PROPERTY LANE <br /> I HERESY CERTIFY THAT 1 HAVE PEPAMD THIS APPLICATION AND THAT TRA.WORK WR.L BE DONE IN ACCORDANCE WITH CMN JOAOUM COUNTY OROINANCEB AND STATE LAWS,AND RULES <br /> AND REGULATIONS OF 7HE SAN JDAOUN COUNTY.HOME OWNER ORLXCENSEC AGENT'S SIGNATURE CEATIFIEB THE FOLLOWING:'I CEMIPYTHAT IN THE POWOFMANCE OF THE WORK"WHICH <br /> THIS PERMIT iS ISSUED,I SHALL NOT EMPLOY ANY PERSON SUCH A MANNER A$TO BECOME SUBJECT TO WOF4VAAN'S COMPENSATION LAWS OP CAUFORNIA.'CONTRACTOR'S HIRING OR <br /> SUS4:0 CE THE FOLLOWNO- CERTIFY THAT IN IVM PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT 0180UED,I SHALL EMPLOY PERSONS SUBJECT TO <br /> WORKMAN•G OMPE N OFC WT CALL.34 NONAN M ADVANCE FUR ALL REDIMED#=PSCIIONB. COMPLETE DRAWING BROW. <br /> SIGNED X ^� <br /> � TT:T.F' <br /> PLOT PLAN(DRAW 70 SCALE)SCALE 'm <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNOING THE PROPERTY, 4.LOCATION OF HOUSE SEWAGE ORBPOBAL SYSTEM OR PROPOMO <br /> 2.OUTUNE OF THE PWPERTY.WLTHIMYST <br /> DIMENSIONS AND NORTH DIFFCTION. EXPANSION OF SEWAGE DISPOSAL REMS. <br /> 3. CAKNMNED OUTLRNE8 AND LOCATION OF ALL EXISTING ANO PROPOSED BTRUCTWES, G.IACATON OF WELLS WNR WM RADIOS OF ONE NUNDL+EO FIFTY FT.ON <br /> INCLUDING CoVEPED AREAL SUCH AS PATIOS,Mr.XWAYR.ANBD wW Ao_._ }�\ THE PIDPI ITY OR ADJORSNG PROPERTY, <br /> I Y Taub <br /> !� <br /> C" `4 <br /> v, <br /> . ,. ILJSk!tSL.L. , <br /> 1 <br /> . ... <br /> __ CT <br /> ... ..".. 1 �4' ENV)ONMENiAI,H S <br /> CE' C <br /> .. . .... . •OW SNoN.. <br /> FOR D"AAT%MT USE ONLY <br /> AMICATON ACCEPTED BY /Y „r DATE, <br /> TAMC,PR OR BUMP WSP%MORI BY DATEE-- ILT�NFINAL Bp1C7ION NY PATE 1 /LJ)'�I„'SP <br /> ADDITIONAL COMMENTS: - {.�, ,JDjI <br /> rte` Q• L�— <br /> ACCI'.UN'TINO ONLY: RADE FACS <br /> PE CODE FEE INFO AMOUNT REMITTED !CASHRIECBVFD 6Y SR I FBSMIT NLR7apL INVOICE J <br /> DATE <br /> 0 J ,,0 O <br /> Sk 00!2i 1�-- <br />